title: Level of lactate in amniotic fluid and its relation to the use of oxytocin and adverse neonatal outcome.
abstract: OBJECTIVE
  To assess whether the frequency of adverse neonatal outcome at delivery is related to the level of lactate in amniotic fluid and to the use of oxytocin.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Soder Hospital, Stockholm, Sweden.
  
  
  METHODS
  Seventy-four women in active labor with a gestational age ≥36 weeks and mixed parity.
  
  
  METHODS
  Levels of lactate in amniotic fluid were analyzed bedside from an intrauterine catheter every 30 min during labor. Deliveries were divided into groups with and without oxytocin.
  
  
  METHODS
  The frequency of adverse neonatal outcome at delivery.
  
  
  RESULTS
  Of the deliveries 13.5% (10/74) concluded with an adverse neonatal outcome. The levels of lactate in amniotic fluid increased during labor, more so in deliveries where oxytocin was used. In the group with an adverse neonatal outcome, the level of lactate in amniotic fluid was significantly higher in the final sample before delivery (p = 0.04). In 18 deliveries, stimulation with oxytocin was temporarily halted for at least 30 min due to overly stimulated labor contractions. A decreasing level of lactate in amniotic fluid was shown within a median 5%/30 min. In the group where the administration of oxytocin was halted, there was no adverse neonatal outcome.
  
  
  CONCLUSIONS
  The frequency of adverse neonatal outcome was associated with the level of lactate in amniotic fluid and with the use of oxytocin. The level of lactate in amniotic fluid may be an additional valuable tool when oxytocin is administered during labor.
authors.affiliation: Department of Clinical Science and Education, Section of Obstetrics and Gynecology, Karolinska Institute, Söder Hospital, Stockholm, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Wiberg-Itzel
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Pembe
authors.forename: Susan
authors.initials: S
authors.lastname: Wray
authors.forename: Anna-Carin
authors.initials: AC
authors.lastname: Wihlbäck
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Darj
authors.forename: Irene
authors.initials: I
authors.lastname: Hoesli
authors.forename: Helena
authors.initials: H
authors.lastname: Åkerud
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000737:chemistry* / Q000187:drug effects; D001034:Apgar Score; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D019344:Lactic Acid / Q000032:analysis*; D010121:Oxytocin / Q000008:administration & dosage*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies
chemical_list: D019344:Lactic Acid; D010121:Oxytocin
keywords: Adverse fetal outcome; amniotic fluid; anaerobe metabolism; lactate; overstimulation; oxytocin